Q. I have heard that many people suffer from pain after the breast augmentation. Is there no way that you cannot feel any pain?

A. If you do not touch any nerves, then there would be no pain.



What should one do to avoid any pain? This is an obvious answer, but one should not touch the nerves to avoid pain.

Then, what are the parts without nerves? There are no nerves on the subcutaneous fat.
How about the skin? The skin is very sensitive, more so any other part of the body. This is the first barricade that protects our body. But once you penetrate through the skin and get into the subcutaneous fat, one will not be able to feel the pain.

Before, I posted on the above the pectoralis muscle and below the muscle procedures for the breast augmentation. Above the pectoralis muscle means that the surgery is done under the subcutaneous fat. There is no pain when the incision in done here. You would not feel any pain with the sadation in the above the pectoralis muscle breast augmentation.

Then how about the bone? Does a bone have nerves?
Do you know the words “pain from carving your bones”? In oppose to this, there is no nerve in your bones.

The bone does not feel the pain, but the surrounding periosteum does. If you touch the periosteum during the incision, then there would be much pain.




If you look at the image above, you will be able to know why approach from the armpit leads to much pain.
This is approaching the periosteum that surrounds the ribs. The tools used for incision might touch the periosteum surrounding the ribs. Therefore, there is much pain when approaching from the armpit.

Of course, you can avoid pain when approaching from the armpit with the usage of the endoscope and investing much time in the surgery. However, the inframammary fold leads to least pain. There is no possibility of touch the periosteum when approaching from the inframammary fold therefore, this method is the most ideal one for a surgery without pain.

Another important point is,
That the bleeding and the pain are related to one another. The blood vessels and the nerves are usually together. So if there is much bleeding then one must have touched the nerves a lot as well. If there is no bleeding then there is no pain.




This image shows the perforator. A method that makes it easy to see these perforator is the approach from the inframammary fold. It is difficult to see these perforators with other methods. If you cannot see somethings properly then this means that there is much chance of bleeding as well.

When we approach from the inframammary fold, we are able to see the location of the blood vessels, therefore, we can avoid the bleeding and minimize the pain caused.
Now, I am sure that you will know that method leads to least pain.

1)
Inframammary fold leads to least pain as there is less chance of irritating the periosteum. The incision does not irritate the periosteum when you approach from the inframammary fold. Look at the image for better understanding.
One cannot avoid irritating the periosteum when approaching from the armpit. The curve from the ribs and the breastbone leads to high chances of touching the periosteum. When the incision is done on the areola, you can avoid irritating the periosteum however, one’s visual gets limited as you approach the inner parts, therefore this cannot be less painful than the inframammary fold incision.

2)
Whatever incision method you use, above the pectoralis muscle, i.e. below the subcutaneous fat incision leads to least or no pain. When the surgery is done through the belly button, the patient cannot feel any pain because the incision is done above the pectoralis muscle. Many say that the incision on the armpit leads to much pain, but the same on above the pectoralis muscle leads to no pain.

However, above the pectoralis muscle method should be well considered when applying for those patients who are really thin. An implant is a foreign substance to the body, therefore such foreign substance needs to be completely covered up when put into the body.

The above the pectoralis muscle means that there is not much skin covering the implant therefore the implant can be seen from outside over time.

Today, we looked at why the inframammary fold incision leads to least pain.
Another important fact is that the surgeon with much experience in inframammary fold incision needs to conduct the surgery to result in less or no pain. There can be much bleeding the pain if the surgeon is not experienced.

Take care and thank you for reading.

Why is 24 hour recovery important?

My patients tell me that they come to me because of the quick recovery from the breast augmentation.
Today, let’s look at why quick recovery time is important and how this can be achieved.

Here is the summary of 24 hour recovery system so that you can understand it easily.




Whatever surgery it is, a good surgery is one that least bothers your daily routine. This applies especially well for the cosmetic surgery more so than other health or physical function related surgeries.

The discomfort and pain from the surgery should be minimized and the social or economic activities of the person should not be restricted.

A surgery that does not penetrate important parts of the body and that ends quickly so that the patient can get back to daily life quickly leads to less possibility of complications also. If the night is long, then you will dream more. If the surgery takes long time and is very complicated, there is much possibility of increasing problems.



A world renowned breast augmentation specialist, Dr. John B. Tebbetts from Dallas, US, first introduced up with the 24 hour recovery system.

24 recovery needs careful analysis of the surgery, clear understanding of the patients, good preparation of the anesthesia and the surgery, and well prepared manpower that helps coordinate the surgery properly from the start to finish without any hesitation.


 
In order for 24 hour recovery to be successful,

Accurate planning before the surgery is very important
Everything needs to be decided in the first meeting with the patient.
What type of implant to use?
Is the size appropriate, what spec or profile to use?
How the symmetry should be controlled,
What is the problem that needs to be solved foremost?
Where to approach for the incision?
If the wrong decision is made in any of the question above, the surgery will be complicated and the recovery would be painful and slow to the patient. There would be higher possibility of side effects as well.



It is better to choose the inframammary fold approach for 24 hour recovery. This applies more so if the anatomical implant is used.
The inframammary fold approach leads to accurate and no fault surgery.
In oppose to this, if the approach is made far away from the breast, the surgery becomes more complicating, longer and the number of variable for the surgery increases. There would be more pain and the recovery takes longer than 24 hours.
I approach from the armpit often, and there is higher possibility of fault with this approach than the inframammary fold approach.
There is no one who wants to take risk on the surgical bed. Accuracy and certainty are very important in a surgery therefore there are many doctors around the world who choose and apply the inframammary fold approach.



A doctor’s technique is important for the 24 hour recovery. The doctor should not give any trauma to the patient and have the skills to perform the surgery quickly and accurately. The procedure should be conducted according to the surgery plan and should not be influenced by any variables caused during the course of the surgery. In fact, this is what determines the result of the surgery.

Also, other surrounding variables such as the surgery environment, tools and devices, endoscope, anesthesia and the experienced nursing staff are all important for the 24 hour recovery

There are many who are misunderstood about the 24 hour recovery system.
A quick surgery and recovery are necessary to result in a beautiful looking breast with no complications.

Quick recovery is not the ultimate goal. Quick recovery is necessary for the good outcome of beautiful looking breasts. Quick recovery means that the surgery was done without any problems or hesitations. This leads to less side effects as well.

Today’s post was for those who perceive that the breast augmentation is something that is scary and painful. The recent advances in the breast augmentation is the 24 hour recovery system.

Thank you for reading. Have a great day.

Q) I have heard that if I get dual plane breast augmentation, my breasts would end up looking anatomical so I do not need to use the anatomical implants. Is this true?

There are growing number of people who ask me the question stated above. I do not know what to do if I get asked such question, but there is the answer first. Dual plane and anatomical implant breast augmentation are completely different concepts. This is similar to saying that you can taste watermelon when you are actually eating round shaped pumpkin.



Dual plane refers to the depth of the implant put in, i.e. the location that the implant is put in to.
Anatomical implant breast augmentation refers to the anatomical implant that is used for the augmentation.

These two cannot be the same. They have different objectives and purposes.






Dual plane is applied in order to reduce the side effects and improve on the disadvantages, and anatomical implant is used for cosmetic reasons.




Today, we looked at the two concepts of dual plane and anatomical implant breast augmentation and how they are different. There are many deceiving information in breast cosmetic surgeries.

 Thank you for reading. Thanks.

Choosing the right size anatomical implant for breast augmentation

This is another frequently asked question. Today, I would like to post an answer on “How to choose the appropriate size of implant when getting a breast augmentation?”











I think that you would be able to catch the point after seeing the image above.
You might also wonder how a large sized anatomical implant is put into a body of a patient who is very thin.

What happens when an implant that is larger in width compared to the breast diameter is used? If you have a narrow thorax, you might be able to feel the implant from the outside. If you are one with funnel chest, the implants on both sides might come and stick together in the middle. This is a high possibility for skinny and thin patients.

If you have more flesh, your skin would be thick, therefore you might not feel the implant although it is larger than the diameter size of your breast. However, in such case, the implant inside your breast might be folded or squashed.

Implant being squashed means that the outer layers are folded. This would lead to implant collapse.

This is why I mentioned an example of parking spot earlier. A car is limited in terms of width, but not in height or length.






The image below shows a very thin woman with 320cc cohesive gel anatomical implant.
Being skinny is one problem, but having a tight skin is another factor that makes it difficult to use large sized implant. A round type implant at about 320cc would need a diameter that is longer than 12.5cm. But an anatomical implant that is long and thick, for example, Optimom from Polytech, a company in Germany, has 320cc in diameter of 11cm.






The patient is very thin, therefore, the breast does not look big although a 320cc implant has been used. This is breast augmentation. For some patients, 200cc might be large enough. For others, 400cc might be small.

But in order for an implant to be put into the pocket size, it is more advantageous to use an anatomical implant that is designed 3 dimensionally and has more variety of choices. It is also better in using a large volume implant.

Today, we looked at the factors in deciding the anatomical implant size for breast augmentation. Have a nice weekend.

Thank you very much.

Q. Is it alright to have sedation or intercostal nerve block (ICNB) for breast surgery? (Anesthesia methods for breast surgery)

A. Yes it is. But the most secure anesthesia is the general anesthesia.



General anesthesia that we talk about in breast surgery mostly refers to inhalational anesthesia.
General anesthesia means intravenous anesthesia and,
ICNB refers to block anesthesia.

If we divide the anesthesia methods into two;

 - General anesthesia; no pain or irritation on the body
 (Anesthesia can be administered through inhalation and intravenous) 
 One loses conscious and goes blurry in this case.



 - Topical anesthesia; No pain or irritation on a particular part of your body
 (Anesthesia can be administered through topical infiltration method and blocking method)
One is conscious in this case.

We can apply any of the methods mentioned above for breast surgeries.
But the most common one is the inhalation, i.e. general anesthesia.
It is because the patient does not feel any pain, therefore the surgery procedure is secure and convenient as there is less reaction from the thorax or muscle when operating.

The sedation that we normally talk about (intravenous anesthesia), is done through propofol. The level of conscious is rather less secure compared to the inhalation types therefore, the body might move during the operation.

 
If the body moves and if the muscles contracts often, the surgery becomes difficult therefore leading to more usage of propofol. Too much usage can lead to the buildup of the anesthesia inside the blood and cause the respiratory center of the central nervous system to lose any senses, resulting in death or brain-death.

Blocking anesthesia such as ICNB cannot be used as a topical one without the drug that reacts on the central nervous system. The drug from sedation is put in with the blocking anesthesia simultaneously.




ICNB cannot be 100% reliable that it will work until the very end of the surgery therefore, one needs to add propofol or midazolam that may lead to similar outcome.



If inhalation anesthesia is used, one does not need to additionally use propofol or midazolam what remains in the body for a long time. Also, although the patient is in a deep physical decline, she will breathe through the respiratory tube therefore, she has the lowest possibility of suffering medical accidents such as death or brain-death.


Everybody wants to ‘wake up and feel nothing’ after a surgery.
When this is achieved, one can say that the most successful anesthesia / surgery has been completed.

But in order to achieve this ‘wake up and feel nothing’, one should not promote or advertise that the anesthesia is simple.

Simple anesthesia leads to more accidents in reality.

There was a known story about a middle school girl who suffered brain-death after the eye and nose cosmetic surgery. After this event, the number of advertisement about the sedation used for breast augmentation has been reduced. Breast surgery with general anesthesia and inhalation anesthesia leads to quick surgery time, and most comfortable state for the patient after the surgery to get back to her daily life.

Has this content helped you out? Thank you. Have a great day.